Healthcare Provider Details

I. General information

NPI: 1497597744
Provider Name (Legal Business Name): ANGELA MARTIROSYAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 ALGONQUIN RD
ROLLING MEADOWS IL
60008-3607
US

IV. Provider business mailing address

2215 ALGONQUIN RD
ROLLING MEADOWS IL
60008-3607
US

V. Phone/Fax

Practice location:
  • Phone: 224-735-2279
  • Fax:
Mailing address:
  • Phone: 847-520-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019035113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: